Cystoscopy

Test Overview

Cystoscopy is a test that allows your doctor to look at the inside
of the
bladder and the
urethra using a thin, lighted instrument called a
cystoscope.

The cystoscope is inserted
into your urethra and slowly advanced into the
bladder. Cystoscopy allows your doctor to look at
areas of your bladder and urethra that usually do not show up well on X-rays.
Tiny surgical instruments can be inserted through the cystoscope that allow
your doctor to remove samples of tissue (biopsy) or
samples of urine.

Small
bladder stones and some small growths can be removed during cystoscopy. This may
eliminate the need for more extensive surgery.

Why It Is Done

Find the cause of symptoms such as blood in the urine
(hematuria), painful urination (dysuria),
urinary incontinence, urinary frequency or hesitancy,
an inability to pass urine (retention), or a sudden and overwhelming need to
urinate (urgency).

Find the cause of problems of the urinary tract, such as
frequent, repeated
urinary tract infections or urinary tract infections
that do not respond to treatment.

Look for problems in the urinary tract, such as blockage in the
urethra caused by an enlarged
prostate,
kidney stones, or tumors.

Evaluate problems that cannot be seen on
X-ray or to further investigate problems detected by
ultrasound or during
intravenous pyelography, such as kidney stones or
tumors.

Remove tissue samples for biopsy.

Remove foreign
objects.

Place ureteral catheters (stents) to help urine flow from
the kidneys to the bladder.

Treat urinary tract problems. For example, cystoscopy can be done
to remove urinary tract stones or growths, treat bleeding in the bladder,
relieve blockages in the urethra, or treat or remove tumors.

Place
a catheter in the ureter for an X-ray test called retrograde pyelography. A dye
that shows up on an X-ray picture is injected through the catheter to fill and
outline the ureter and the inside of the kidney.

How To Prepare

Have had bleeding problems or take blood-thinning medicine, such
as aspirin or warfarin (Coumadin).

Are or might be pregnant.

Cystoscopy can be performed with
local, spinal, or general anesthesia. Discuss with
your doctor which method is best for you and whether you should plan on staying
overnight in the hospital. If you will not be staying in the hospital, arrange
for someone to drive you home after the test.

Follow the instructions exactly
about when to stop eating and drinking, or your surgery may be canceled. If
your doctor has instructed you to take your medicines on the day of surgery,
please do so using only a sip of water.

You should empty your bladder just before the test. You
may be given medicine to prevent a urinary tract infection that could be caused
by the test.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the
test, its risks, how it will be done, or what the results may mean. To help you
understand the importance of this test, fill out the
medical test information form(What is a PDF document?).

How It Is Done

Cystoscopy is performed by a
urologist, with one or more assistants. The test is
done in a special testing room in a hospital or the doctor's office.

You will need to take off all or most of your clothes, and you will be
given a cloth or paper covering to use during the test.

About an
hour before the test, you may be given a
sedative to help you relax. An intravenous (IV) needle may be placed in a vein in your arm to give
you other medicines and fluids. You will lie on your back on a special table
with your knees bent, legs apart, and your feet or thighs may be supported by
stirrups. Your genital area is cleaned with an antiseptic solution, and your
abdomen and thighs are covered with sterile cloths.

If a
local anesthetic is used, the anesthetic solution or
jelly is inserted in your urethra.

If a
general anesthetic is used, you will be put to sleep
either with a medicine given through an IV or by inhaling gases through a mask,
or both methods may be used.

If a
spinal anesthetic is used, the area on the back where
the needle will be inserted is first numbed with a local anesthetic, then the
needle is guided into the spinal canal and the anesthetic is injected. A spinal
anesthetic may prevent movement of the legs until the anesthetic wears off.

After the anesthetic takes effect, a well-lubricated cystoscope
is inserted into your urethra and slowly moved into your bladder. If your
urethra has a spot that is too narrow to allow the scope to pass, other smaller
instruments are inserted first to gradually enlarge the opening.

After the cystoscope is inside your bladder, either sterile water or
saline is injected through the scope to help expand your bladder and to create
a clear view. A medicine may also be injected through the scope to reduce
chances of infection. Tiny instruments may be inserted through the scope to
collect tissue samples for biopsy; the tissue samples then are sent to the
laboratory for analysis.

The cystoscope is usually in your bladder
for only 2 to 10 minutes. But the entire test may take up to 45 minutes or
longer if other X-ray tests are done at the same time.

If a local
anesthetic is used, you may be able to get up immediately after the test. If a
general anesthetic is used, you will stay in the recovery room until you are
awake and able to walk (usually an hour or less). You can eat and drink as soon
as you are fully awake and can swallow without choking. If a spinal anesthetic
was used, you will stay in the recovery room until sensation and movement below
your chest returns (usually about an hour).

How It Feels

Most people report that this test is not
nearly as uncomfortable as they had expected.

If a general
anesthetic is used, you will feel nothing during the test, but after the
anesthetic wears off your muscles may feel tired and achy. Some people
experience nausea after receiving a general anesthetic.

If a local
anesthetic is used, you may feel a burning sensation or an urge to urinate when
the instrument is inserted and removed. Also, when your bladder is irrigated
with sterile water or saline, you may feel a cool sensation, an uncomfortable
fullness, and an urgent need to urinate. Try to relax during the test by taking
slow, deep breaths. Also, if the test is lengthy, lying on the table can become
tiring and uncomfortable.

If a spinal anesthetic is used, you may
find it uncomfortable to lie curled up on your side while the anesthetic is
injected. You will probably feel a brief stinging sensation when the anesthetic
is injected. You may feel tired and have a slight backache the day after the
test.

Risks

Cystoscopy generally is a very safe test. If a
general anesthetic is used, there are some
risks of general anesthesia. There is no risk of loss
of sexual function.

The most common side effect is a temporary
swelling of the urethra, which may make it hard to urinate. A catheter
inserted in your bladder can help drain the urine until the swelling goes away.
Bleeding sometimes occurs, but it usually stops on its own.

You
may have a mild infection in the urinary tract after cystoscopy. This can
usually be prevented or treated by taking medicine before and after the test.
In rare cases, the infection can spread through the body, and in very rare
circumstances, usually with seriously ill people, the infection can be
life-threatening.

Another rare complication is a puncture of the
urethra or bladder by one of the instruments, which requires surgery to
repair.

After the test

After the test, you may need to
urinate frequently, with some burning during and after urination for a day or
two. Drink lots of fluids to help minimize the burning and to prevent a urinary
tract infection.

A pinkish tinge to the urine is common for
several days after cystoscopy, particularly if a biopsy was performed. But call
your doctor immediately if:

Your urine remains red or you see blood clots after you have
urinated several times.

You have not been able to urinate 8 hours after the
test.

You have a fever, chills, or severe pain in your flank or
belly. These may be signs of a
kidney infection.

You have symptoms of a
urinary tract infection. These symptoms include:

Pain or burning upon urination.

An urge to urinate frequently, but usually passing only small
quantities of urine.

Dribbling or leakage of urine.

Urine that is reddish or pinkish, foul-smelling, or
cloudy.

Pain or a feeling of heaviness in the lower abdomen.

Results

Cystoscopy is a test that allows the
doctor to look at the inside of the
bladder and the
urethra. Your doctor may be able to talk to you about
some of the results right after the cystoscopy. The results of a
biopsy usually take several days to be
available.

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